Sasha and Malia Versus the FDA

| February 29, 2012 | 0 Comments

President Obama with daughters Sasha and Malia

Access to reproductive healthcare is an inflammatory subject matter, often discussed in ideological rather than medical terms.  Its attachment to sexuality and social norms distracts the public, legislators, and the judiciary from the de facto result of confounding morality with medicine.  In other words, notions of virtue are relevant to families, not the state, and replacing evidence-based policy with dogma leaves women without care, regardless of the circumstances that placed them in need.

Within the United States, it is becoming increasingly difficult for women to maintain reproductive health.  46 states have pushed forward “pro-life” legislation and in 2011 alone, state legislators introduced over 900 bills limiting reproductive services, [1] including:

(1)    “fetal pain” laws [2] (prohibiting abortion after 22 weeks);

(2)    consent clauses [3] (requiring a minor seeking an abortion to obtain written (and sometimes notarized) consent from both parents);

(3)    bans on medical abortions; [4]

(4)    mandatory ultrasound laws (requiring women to listen to verbal description of her fetus); [5]

(5)    prohibitions on nurse practitioners’ prescribing power over emergency contraception; [6]

(6)    a narrowly voted down “personhood” initiative (banning abortion, many forms of contraception, and potentially in vitro fertilization); [7]

(7)    restrictions on the use of Medicaid funds to cover emergency abortions [8]

(8)    requirements that a physician counsel a patient on the risks associated with abortion days before performing the procedure [9] (forcing patients who travel long distances to secure lodging near the facility for up to two nights); and

(9)    stringent building code regulations attached to abortion licensing requirements [10] (the de facto result of which is to shut down every clinic in a state).

The Obama administration has been similarly reactive towards women’s health, suggesting that the President’s commitment to equality has caveats.  For the first time in history, the Secretary of the Department of Health and Human Services (HHS) contradicted a scientific finding by the Food and Drug Administration (FDA) – that “Plan-B One Step” (a simplified formulation of emergency contraception) is safe for women and girls of all reproductive ages, and thus appropriately administered without a prescription.  A portion of the Senate admonished the HHS for replacing evidence-based rationale with dogma, but President Obama expressly voiced his support for the Secretary’s unsubstantiated move.  He reasoned that the innocence of his two daughters outweighed the proven safety of the drug, not only making an incongruous appeal to ideology over science but also confounding the practice of medicine with his own parenting. [11] Last year, he responded similarly to “pro-life” legislators who insisted they would not support the Patient Protection and Affordable Care Act (ACA) without “maintaining the principle of the sanctity of life.” [12] Obama provided executive assurance that previous restrictions on federal funding of abortion would endure, despite the fact that the ACA already included such provisions. [13]

Indeed, the federal government often promulgates “laws to protect conscience” [14] that not only prioritize dogma over medicine but also are repetitive of existing provisions, advancing rhetoric rather than new policy.  For example, the federal Church Amendment prohibits any federally funded (in whole or in part) healthcare institution from requiring an individual to perform sterilization or abortion services (even where the life of the woman is at risk) [15] and the Weldon Amendment reaffirms that these entities cannot discriminate against a provider for unwillingness to provide these services. [16]  Despite these laws, which are still in force, a bill currently before the House reiterates these principles once again, providing that hospitals with conscientious objector status are exempt from the federal requirement that a pregnant woman cannot be denied emergency care out of concern for her fetus. [17]  These provisions clash with professional standards of care, threatening the lives of women.  Indeed, they give force to the Catholic Church’s mandate that affiliated hospitals refuse to terminate a fetus, even where necessary to protect the health of a woman. [18]

The United States is perpetuating this ideological approach to healthcare around the globe as well, asking low-income states to forgo evidence-based medicine in the name of donor driven priorities.  For example, USAID funds family planning methods globally.  Yet one of its best practice partnerships is a 38 million USD “Fertility Awareness-Based Method (FAM)” Cooperative Agreement with Georgetown University’s Institute for Reproductive Health, supporting the “scale-up” of the Standard Days Method (SDM) – avoiding unprotected intercourse on certain days of one’s menstrual cycle, using a bead counting system.  The art of successful avoidance is not a part of SDM; perhaps not surprisingly then, the Institute does not track unwanted pregnancies.  Although “scaling-up” is the World Health Organization’s systematic approach to expanding proven innovations, [19] USAID has funded the use of this model as applied to an empirically unsound method of family planning.  In fact, instead of collecting data that reflects efficacy, the Institute tracks “provider understanding” and the ability to convey the SMD “message” to patients.  In plain terms, rather than funding the dissemination of evidence-based contraceptive methods, USAID is spending millions to teach providers to count beads.

Notions of righteousness justify cultural fundamentalism that has provided the basis not only for restrictions on reproductive care, but also genital cutting, stoning adulterous women, and abandoning women who suffer horrible complications in childbirth.  Is one more acceptable than the other?

In a nation predicated upon equality and inalienable individual rights, we must allow each woman to decide for herself when reproductive services are necessary.  Indeed, if we want to promulgate “pro-life” policies, we will provide women with the resources they require to secure health, promoting both female and fetal life.  President Obama, as you face a tough political battle ahead, you would be well-advised to prove you are dedicated to equality not merely in terms of class and race, but gender as well.

 


[1] Guttmacher Institute, State Center.  Laws affecting reproductive health and rights: trends in the first quarter of 2011. http://www.guttmacher.org/statecenter/updates/2011/statetrends12011.html.

[2] Kansas House Bill 2218 (2011).

[3] Kansas House Bill 2035 (2011); North Carolina S. Bill 766 (2011).

[4] Oklahoma House Bill 1970 (2011).  A temporary injunction has blocked implementation of Oklahoma’s law.  Oklahoma Coalition for Reproductive Justice v. Cline (Oklahoma Dist. Ct., 2011).

[5] Arizona H. Bill 2416 (2011); Texas House Bill 15 (2011).  A temporary injunction has blocked implementation of Texas’ law.  Texas Medical Providers Performing Abortion Services v. Lakey (W.D.Tex., 2011).

[6] Arizona S. Bill 1030 (2011).

[7] Eckholm E. Voting on conception as the legal start of life. NYTimes. Oct. 26, 2011.

[8] The “DC abortion ban” is a rider attached to the FY 2012 federal budget.

[9] Arizona S. Bill 1175 (2009); South Dakota CL 34-23A-10.1. A district court temporarily enjoined enforcement of South Dakota’s 72 hour waiting period requirement. Planned Parenthood v. Daugaard et al. (Dist. SD Southern Div, 2011).

[10] Kansas Senate Bill 36 (2011). A court temporarily enjoined enforcement of this law. Hodes & Nauser v. Moser (Kansas Dist. Ct., 2011).

[11] White House Press Conference, Dec. 8 2011.

[12] Former Representative Bart Stupak.

[13] Consolidated Appropriations Act (“Hyde Amendment”), § 507 (2008).

[14] The White House. Executive Order – Patient Protection and Affordable Care Act’s Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion. March 24, 2010.

[15] Public Health Service Act, 42 USC § 300a-7 (1973).

[16] Consolidated Appropriations Act, Weldon Amendment, P.L. 110-161 (2008).

[17] U.S. House of Representatives Bill 358 (2011).

[18] Directive issued by the United States Conference of Catholic Bishops.

[19] See Fajans P, Simmons R, Ghiron L. Helping public sector health systems innovate: the Strategic Approach to Strengthening Reproductive Health Policies and Programs. American Journal of Public Health, 2006, 96:435-440; The WHO Strategic Approach to strengthening sexual and reproductive health policies and programmes. Geneva, World Health Organization, 2009, http://www.who.int/reproductivehealth/topics/countries/strategic_approach/en/index.html.

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